Abstract

Objective To compare media/marketing exposures and family factors in predicting adolescent alcohol use.

Design Cohort study.

Setting Confidential telephone survey of adolescents in their homes.

Participants Representative sample of 6522 US adolescents, aged 10–14 years at baseline and surveyed four times over 2 years.

Primary outcome measure Time to alcohol onset and progression to binge drinking were assessed with two survival models. Predictors were movie alcohol
exposure (MAE), ownership of alcohol-branded merchandise and characteristics of the family (parental alcohol use, home availability
of alcohol and parenting). Covariates included sociodemographics, peer drinking and personality factors.

Results Over the study period, the prevalence of adolescent ever use and binge drinking increased from 11% to 25% and from 4% to
13%, respectively. At baseline, the median estimated MAE from a population of 532 movies was 4.5 h and 11% owned alcohol-branded
merchandise at time 2. Parental alcohol use (greater than or equal to weekly) was reported by 23% and 29% of adolescents could
obtain alcohol from home. Peer drinking, MAE, alcohol-branded merchandise, age and rebelliousness were associated with both
alcohol onset and progression to binge drinking. The adjusted hazard ratios for alcohol onset and binge drinking transition
for high versus low MAE exposure were 2.13 (95% CI 1.76 to 2.57) and 1.63 (1.20 to 2.21), respectively, and MAE accounted
for 28% and 20% of these transitions, respectively. Characteristics of the family were associated with alcohol onset but not
with progression.

Conclusion The results suggest that family focused interventions would have a larger impact on alcohol onset while limiting media and
marketing exposure could help prevent both onset and progression.

Footnotes

Funding The study was funded by the National Institutes of Health (AA015591 and CA077026, JDS principal investigator, and CA071789
and DA021856, TAW principal investigator).

Competing interests None.

Contributors All authors contributed to the conception and design of the study and were part of the development of the surveys deployed
in the study. MS conducted the data analysis. All authors had a hand in the interpretation of the data, the critical revision
of the manuscript and all approved of the final version.

Data sharing statement Statistical code and a partial analysis data set (with variables pertaining to this manuscript) are available from the corresponding
author. Informed consent was not obtained for data sharing, but the data that would be shared have no personal identifiers.
Requests for use of the aforementioned data will not be granted without approval by the Dartmouth and the recipient's human
subjects committees.